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NPI Code Detail

MEDICARE: DR. DAVID CANDELARIA M.D.

MEDICARE: DR. DAVID CANDELARIA M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine PhysicianMD17629OR
2207Q00000XFamily Medicine Physician31332CO

General Provider Information

NPI Number : 1033112271
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. DAVID CANDELARIA M.D.
Provider Business Mailing Address
First Line : PO BOX 490
Second Line :
City : GRANTS PASS
State : OR
Zip : 97528-0041
Country : US
Telephone Number : 541-955-4655
Fax Number : 541-955-4655
Provider Business Practice Location Address
First Line : 280 MAPLE ST
Second Line :
City : ASHLAND
State : OR
Zip : 97520-1552
Country : US
Telephone Number : 541-201-4000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/23/2005
Last Update Date : 09/03/2011

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Directions to “ DR. DAVID CANDELARIA M.D.” Practice Location

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